Aim: To evaluate the laparoscopic approach to adrenalectomy throughout a decade in a single area, focussing on complication rates and the effect of surgeon experience. Given the relative rareness and pathological heterogeneity of adrenal tumors, there is still some debate as to whether the laparoscopic approach is suitable for all situations. Initially, laparoscopy was not recommended for pheochromocytomas, because of the possibility of adrenergic crisis. Subsequent questions were raised as to its appropriateness for large tumors (>6 cm) and metastatic deposits due to the technical difficulty of dissection. There has also been an increased number of incidental tumors (‘incidentalomas’) discovered while imaging for other reasons (e.g., on CT or MRI).
Materials and methods: De-identified data was collected of all laparoscopic adrenalectomies within the last decade via electronic and physical chart review, in addition to review of pathology reports.
Results: Ninety-seven adrenalectomies were performed. The complication rate was 8%, and 40% of cases were incidentalomas. Tumor pathologies noted were: non-secretory adenomas (35%), aldosterone-secreting adenomas (18.6%), adrenal metastases (17.5%), pheochromocytomas (13.4%), simple cysts (4.1%) and other pathologies (11.3%). The most significant decrease in operative time was between 2005–2008 and 2009 (p <0.0001). No significant relationship between complications and size of a tumor, nor pathology of a tumor was found.
Conclusion and clinical significance: Laparoscopic adrenalectomy in this center has a complication rate similar to other published rates and appears to be a safe procedure for large tumors and various pathologies. There is also a demonstrable effect of surgeon experience on operative time.
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